Profuse Diarrhea after Misoprostol Use in a Patient with a History of Crohn's Disease

OBJECTIVE: To report a case of profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease and to discuss the role of eicosanoids in Crohn's disease. DATA SOURCES: Patient medical records, case reports, review articles identified by MEDLINE, and personal communication with the physician, patient, and manufacturer. DATA EXTRACTION: From interviews, the manufacturer, and pertinent published sources by one author and reviewed by the others. DATA SYNTHESIS: A 55-year-old woman presented to clinic complaining of multiple joint pains. Her medical history was significant for peptic ulcer disease, hypertension, and Crohn's disease in remission since May 1989. Her joint pains were treated with ibuprofen 600 mg po qid and misoprostol 200 μg po qid (after meals and at bedtime). Following the administration of three doses of ibuprofen and misoprostol, the patient experienced abdominal cramps, pain, and voluminous, watery diarrhea for two days. Upon discontinuation of the ibuprofen and misoprostol, all of her gastrointestinal symptoms resolved within 12 hours. Rechallenge with ibuprofen alone failed to produce a recurrence of symptoms. Enhanced synthesis of intestinal eicosanoids has been demonstrated in Crohn's disease. Misoprostol, a synthetic analog of one of the eicosanoids, could induce a flare-up of Crohn's disease as suggested in this patient. CONCLUSIONS: Misoprostol should be used with caution in patients with known inflammatory bowel disease.

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Interesting case of dual pathology: Crohn’s disease and Peutz-Jeghers syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-234513 ◽

2020 ◽

Vol 13 (10) ◽

pp. e234513

Author(s):

Mantej Sehmbhi ◽

Penelope Sellers ◽

Jonathan Segal ◽

Susan Clark

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Interesting Case ◽

Night Sweats ◽

History Of ◽

Progressive Weight Loss ◽

Inflammatory Bowel ◽

Peutz Jeghers Syndrome ◽

The Uk

An 18-year-old man presented with fever, night sweats and progressive weight loss over 2 months. He had a history of Peutz-Jeghers syndrome (PJS) complicated by previous intussusception requiring left hemicolectomy. Colonoscopy revealed deep punched out ulceration throughout the colon with multiple polyps. He was investigated for tuberculosis based on his occupation as dairy farmer. Following a negative QuantiFERON test, he was started on infliximab as emergency therapy and made a good recovery at 6 months follow-up. We describe a case of newly diagnosed Crohn’s disease (CD) in an adolescent with a background diagnosis of PJS. While inflammatory bowel disease, such as CD, is common in the UK, the association with PJS is very rare, with only two existing case reports in the literature.

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Metastatic Hepatocellular Carcinoma in a Patient with Crohn’s Disease Treated with Azathioprine and Infliximab: A Case Report and Literature Review

Case Reports in Gastrointestinal Medicine ◽

10.1155/2014/340836 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Kyle J. Fortinsky ◽

Ali Alali ◽

Khursheed Jeejeebhoy ◽

Sandra Fischer ◽

Morris Sherman ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Crohn’S Disease ◽

Liver Disease ◽

Crohn's Disease ◽

Case Reports ◽

Future Research ◽

Azathioprine Therapy ◽

Additional Risk ◽

Early Imaging ◽

History Of

Hepatocellular carcinoma most commonly occurs in patients with underlying liver disease or cirrhosis. We describe a case of hepatocellular carcinoma in a 34-year-old man with Crohn’s disease treated with azathioprine and infliximab. The patient had no history of liver disease and a complete autoimmune and viral workup was unremarkable. Unfortunately, the patient developed widespread metastatic disease and passed away 5 months after his initial diagnosis. The mechanism of hepatocellular carcinoma in patients’ with Crohn’s disease is poorly understood and may include both autoimmunity and treatment-related complications. Previous case reports suggest the possibility of a concerning association between azathioprine therapy and the development of hepatocellular carcinoma in patients with Crohn’s disease. Clinicians may consider early imaging in patients with Crohn’s disease presenting with concerning symptomatology or abnormal liver enzymes, especially in those being treated with azathioprine alone or in combination with infliximab. Future research may help to uncover additional risk factors for this exceedingly rare diagnosis in this patient population.

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Cytomegalovirus Infection in a Patient with Crohn’s Ileocolitis

Canadian Journal of Gastroenterology ◽

10.1155/2005/804139 ◽

2005 ◽

Vol 19 (2) ◽

pp. 109-111 ◽

Cited By ~ 2

Author(s):

Sahin Coban ◽

Arzu Ensari ◽

Mehmet Ayhan Kuzu ◽

Samet Yalcin ◽

Murat Palabiyikoglu ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Cytomegalovirus Infection ◽

Histopathological Examination ◽

Stable Condition ◽

Watery Diarrhea ◽

History Of ◽

Inflammatory Bowel

Cytomegaloviral enterocolitis is an uncommon infection that can complicate inflammatory bowel disease. A case of a patient with a three-year history of Crohn's disease is reported. He had been in a stable condition on mesalamine 4 g/day and methylprednisolone 10 mg/day for three years until four weeks before admission. The patient was admitted with complaints of fever, abdominal pain and watery diarrhea. A diagnosis of an exacerbation of Crohn's disease was established. The radiological examination revealed narrowing of the terminal ileum. Multiple fistulas and abscess-like images were observed. The patient then underwent ileocolic resection and ileostomy. The histopathological examination revealed Crohn's ileocolitis with superimposed cytomegalovirus infection. In patients with rapidly deteriorating inflammatory bowel disease, cytomegalovirus infection should be kept in mind as one of the differential diagnoses.

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Asymptomatic Crohn’s disease identified in a patient being treated with secukinumab: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x19893580 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1989358

Author(s):

Wasim Haidari ◽

Sarah Al-Naqshabandi ◽

Christine S Ahn ◽

Richard S Bloomfeld ◽

Steven R Feldman

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Gastrointestinal Symptoms ◽

Good Choice ◽

History Of ◽

Inflammatory Bowel ◽

Multiple Ulcers ◽

New Onset

IL-17 antagonism is among the most potent treatments for psoriasis. Generally safe, new onset and exacerbations of inflammatory bowel disease may occur in association with IL-17 therapy. We describe a patient with long-standing history of psoriasis and psoriatic arthritis in whom asymptomatic Crohn’s disease was identified during treatment with secukinumab. The patient underwent an elective colonoscopy for colorectal cancer screening which revealed inflammation and multiple ulcers in the terminal ileum suggestive of Crohn’s disease. While the patient did not have any gastrointestinal symptoms, he was diagnosed as having asymptomatic Crohn’s disease. Given the association of inflammatory bowel disease with secukinumab treatment, secukinumab was discontinued. Although in this patient, Crohn’s disease was identified during treatment with secukinumab, a direct causal relationship cannot be assumed. Medications that are effective for both psoriasis and inflammatory bowel disease may be a good choice in patients with psoriasis who have comorbid Crohn’s disease or develop inflammatory bowel disease during treatment with another biologic.

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Delayed Diagnosis of Vulvar Crohn’s Disease in a Patient with No Gastrointestinal Symptoms

Case Reports in Dermatology ◽

10.1159/000495000 ◽

2018 ◽

Vol 10 (3) ◽

pp. 263-267

Author(s):

Leah Ellis Wells ◽

David Cohen

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Delayed Diagnosis ◽

Gastrointestinal Symptoms ◽

Symptomatic Improvement ◽

Initial Therapy ◽

Symptom Improvement ◽

Factor Α ◽

Necrosis Factor

Though Crohn’s disease primarily affects the gastrointestinal tract, cutaneous Crohn’s disease of the vulva can occur in the absence of gastrointestinal symptoms, complicating the diagnosis. Once clinicians suspect cutaneous Crohn’s disease, antibiotics and traditional immunosuppressants comprise initial treatment. Unfortunately, sometimes these therapies are not effective, or they provide only short-lived symptomatic improvement. A few case reports have found tumor necrosis factor-α inhibitors to be helpful in such refractory cases. We describe a patient with long-standing, painful vulvar Crohn’s lesions with no gastrointestinal manifestations of the disease. Her diagnosis was delayed for years, and initial therapy with antibiotics and steroids was unsuccessful. Finally, the patient experienced effective and long-lasting symptom improvement with infliximab (RemicadeTM).

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Myopericarditis as an Extra-Intestinal Manifestation of Crohn’s Disease: A Case Report

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/241 ◽

2022 ◽

Vol 5 (1) ◽

pp. 01-05

Author(s):

Rohan Prasad ◽

Surya Chennupati ◽

Tyler Kemnic ◽

Abdullah Al-abcha ◽

Manel Boumegouas ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Case Presentation ◽

Reactive Protein ◽

History Of ◽

St Elevation ◽

Inflammatory Bowel ◽

Small Pericardial Effusion

Introduction: Myopericarditis is an uncommon manifestation of Crohn’s disease. Interestingly enough, it can present in a patient without any acute bowel symptoms. Case Presentation: A 21-year-old male with a medical history of Crohn’s disease and eosinophilic esophagitis presented to the hospital with chest pain and fever. Blood work revealed elevated troponin, C-reactive protein, and sedimentation rate levels. Electrocardiogram (EKG) showed diffuse ST elevation in all leads. Transthoracic echocardiogram (TTE) demonstrated a small pericardial effusion without valvular abnormalities. The patient was diagnosed with myopericarditis. Extensive etiological workup was negative, in the absence of other explanations, it was attributed to his Crohn’s disease. The patient was started on colchicine and ibuprofen. Out-patient follow-up revealed resolution of symptoms. Conclusion: This case reports the rare occurrence of myopericarditis and Crohn’s disease. Inflammatory bowel disease as a cause of myopericarditis has been reported in some cases within the literature; however, there is no definitive mechanism known.

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Recurrent Hepatocellular Carcinoma in Patient with Crohn’s Disease: Incidental or Expected Outcome of Azathioprine?

Case Reports in Gastrointestinal Medicine ◽

10.1155/2015/939136 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Youssef Botros ◽

Mary Mathews ◽

Hiren Patel ◽

Nihar Shah ◽

Walid Baddoura ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Disease Patient ◽

Aminosalicylic Acid ◽

Immune Mediated ◽

Increased Risk ◽

History Of

Hepatocellular carcinoma (HCC) usually occurs in patients with underlying risk factors such as liver cirrhosis and chronic hepatitis B. Although patients with Crohn’s disease (CD) are at an increased risk to develop malignancies such as colon cancer, the incidence of HCC in this population is extremely rare. We report a case of 62-year-old male with long history of CD treated with azathioprine (AZA) and aminosalicylic acid (ASA) who was incidentally diagnosed with HCC, for which left hepatectomy was done. Four years later during routine follow-up, patient had another hepatic lesion and underwent resection of the mass. The mechanism of occurrence of HCC in patient with CD is still controversial and may include immune mediated changes and medication related complications. AZA was reported in all case reports of CD that developed HCC. Through this report we hope to explore the complex pathophysiological mechanisms contributing to the development of HCC in the Crohn’s disease patient population.

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